
112 Reference Material Reference Material 113
SURGEON PREFERENCES
Surgeon
Preferences
Clinic
Woo
o Review all images and review surgical plan prior to clinic
o 2 week
Boyd
o Echo within 3-6 months for Valves
o Cath within 6 months (if CAD), within 1 year if most recent was clean/Valve
o CTa within 3-6 months for Ascending aorta
o Calculate STS score on all patients pre clinic (use most recent or normal
creatinine)
o Calculate Syntax score for all CAD patients
o All notes completed same day of clinic
thromboembolic event
For inpatient CABG consults— see Boyd Consult H&P document
Lee
o Calculate STS score on all patients pre clinic (use most recent or normal creatinine)
o Echo within 3 months
o Cath within 6 months (if CAD), within 1 year if most recent was clean/Valve
o CTa within 3-6 months for Ascending aorta
o CTa (vs CT L atrial mapping) needed for all patient with prior history of ablation/
MAZE
o If pacemaker, obtain make, model, implantation date
o Calculate STS score on all patients pre-clinic (use most recent or normal
creatinine)
o PFTs if any smoking history in last 10 years
o Carotid US if carotid bruit on exam, h/o prior TAI or stroke, age > 65, smoking
history, or family history of stroke
o Obtain bilateral LE duplex US if history of vein stripping
o All notes completed same day of clinic
o DO NOT HOLD ASA PRE-OPERATIVELY
o Post ops:
o MAZE:
o 1-month POV – need ECG during clinic visit (may need TTE if patient’s
most recent TTE prior to discharge had LVEF< 40%).
o 3-month POV -needs 72 hour Ziopatch as close to clinic visit as possible
and a TTE prior to visit.
o 6-month POV – needs 72 hour Ziopatch as close to clinic visit as possible.
o 12- month POV –needs 72 hour Ziopatch as close to clinic visit as possible.
o Annually with 72 hour Ziopatch. VALVE follow up at 1 mos with Echo,
then annually
o CABG fu at 1 mos (Echo only needed if EF decreased at discharge or
< 40% pre op)
o Aortic surgery patients: FU @ 1, 3,6, and 12 months with CT scan
Fischbein o Pre op
o No Tissue consent for Aorta patients
Miller
Hiesinger o Review all images and review surgical plan prior to clinic
SURGEON PREFERENCES, CONTINUED
Surgeon
Preferences
ICU Tele
Woo o DC labs early if able
o Post op CT c/a/p prior to discharge on
Acute Type A dissections only
o Ok to DC home same day PW removed
Boyd
o CABG patients 75mg Plavix daily x1
year
o All patients 200mg PO amio daily
o SubQ heparin for DVT prophylaxis
if no contraindication
o Endocrine consult to manage DM if
elevated A1c
o Daily senna started while in ICU
o FAST TRACK (all uncomplicated
CABG with normal EF)
POD #1:0600; Cordis/
Swan out by 1000 (even if still on
and Plavix
POD #2: Daily labs on case by case
basis. Transfer out of ICU
Overall considerations:
insulin gtt and start diet as early
as possible, ok to eat POD #0. Ok
to remove foley POD 1 even if on
diuretics. If waiting in ICU for tele
bed, ensure PT/OT and patient
mobilization.
o DC labs early if able
o CABG patients 75mg Plavix daily x1 year
o All patients 200mg PO amio daily for
o No Iron on discharge
o Remove PW prior to CT
o SubQ heparin for DVT prophylaxis if no
contraindication
o No imaging needed prior to discharge
o Acute Type A dissection post op CT @
1month follow up appointment
o Endocrine consult to manage DM if
elevated A1c
o For routine CABG, goal is discharge by
at least POD #5
o For myocardial bridge, DC Paravertebral
catheter POD #3 with goal of discharge
by POD #4
Lee o No IV amio gtt, boluses only
o No nicotine patch for CABG
o Avoid Reglan (due to black box
warning and association with
tardive dyskinesia)
o No IV amio gtt, boluses only
o No nicotine patch for CABG
o Coreg no better than metoprolol for
Heart failure patients
o For LAA excision: Inspra 25mg BID
o Avoid Reglan (due to black box warning
and association with tardive dyskinesia)
Fischbein o Do not wean inotropes without
discussing directly
o For patients on high dose pressors
or with high oxygen requirements,
discuss PO diet directly before
initiating
o For post op CABG patients,
continue NTG while on Epi if blood
pressure allows
o Start Epogen/Iron/Vit C in ICU for
post op anemia
o IV Lasix and KCL while inpatient
o Leave central line in place
o PW remain in place until day prior to
discharge
o Prior to discharge:
o Echo all valves
o CT all aortas (with 3D
measurements
o Must approve all discharges
o No IV hydralazine in dissections
o PW out prior to CT if possible
Miller o Avoid hydralazine in Aortic
Dissections/Aneurysm
o Prior to discharge:
o Echo all valves (once PW removed
and within 2kg pre op wt)
o CT all aortas (with 3D
measurements
o Must approve all discharges
o No IV hydralazine dissections
o For LAA excision: Inspra 25mg BID
Hiesinger o Post op imaging per patient- not
standard